The objective of this study is to examine a model of health literacy coaching wherein Meals on Wheels (MOW) volunteers work with older adults to enhance patient communication skills. While considerable progress marks the studying of written health literacy, fewer efforts have addressed interactional health literacy. Interactional factors are posited as mechanisms that link health literacy with health services utilization. Older adults are at particular risk of poor interactional health literacy. Patient communication skills--such as those developed by the Ask-Me-3 program from the Partnership for Clear Health Communication--may redress this problem. MOW volunteers are ideally suited to be health literacy coaches, since they enjoy special status as intimate, welcome, and regular visitors to the otherwise difficult to reach homebound. Previous research affirms that MOW volunteers can conduct health promotion during brief encounters with clients. Two hundred MOW volunteers from rural and urban Georgia will be trained as health literacy coaches. Twelve hundred MOW clients will be randomly assigned to one of three treatments. Some clients will receive meals as usual. For others, MOW volunteers will give clients materials pertaining to Ask-Me-3 and will show brief modeling videos. A third group will in addition receive over the course of a year four coaching sessions prior to health care encounters. To test the generalizability of the intervention, a small replication will be conducted in Portland, Oregon. It is hypothesized that MOW clients receiving intensive coaching will exceed those who just view Ask-Me-3 materials, who in turn will exceed those in the control, in outcomes relating to (1) active participation in a health information context, (2) satisfaction with providers, (3) health self-efficacy, and (4) health status. Furthermore, with each subsequent health literacy coaching session, intensively coached clients will manifest improved (a) comprehension of the medical assessment and orders, (b) intention to comply with recommendations and orders, and (c) fewer communication barriers. The MOW volunteers/health literacy coaches will likewise gain in (i) satisfaction with providers, (ii) written health literacy, and (iii) satisfaction in their volunteerism. Findings will advance understanding of interactional health literacy.